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��� <br />C�� <br />>Hy <br />H�� <br />� � � � <br />�VJH <br />$' <br />o�d <br />��g <br />G]� c] <br />t'y� <br />Ny <br />gy <br />�d� <br />��� <br />HOtn <br />� ,` �. <br />� i- <br />I <br />Date �� � '—� J_� <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />n ( n C� � <br />�'��� < � l � .�l �� .� <br />Mailing Address C��Y <br />Mailing <br />���y <br />PueLc WorAa Perm /— � <br />t� <br />ei�c. oeo�- • <br />ruL..c wo�ks Fea <br />iolalFca S — <br />Les9 /ppl Foe Pe�U S _�—��� <br />oaianceoue a <br />Phone <br />"lC' /�`✓ <br />Describe Proposetl Work � �' �( '� � I1--L! i I ��1 ��tJV� X � C r� 1�X �� I I–/ ' J���'� <br />Project Address (il known) � v� � <br />Attach tour (4) copies ol plans lor proposed work - Oraw to scale and note the following as applicab�e: <br />• Propeny Lines <br />• Outline and dimensions of all evisting antl <br />proposetl struc!ures on the lot <br />• Existing and proposed utilities <br />• Centedine ol streel <br />• Indicate North <br />• Show any propoae�� gratling chan9es <br />• Show measuremi.�is <br />PERNIT CONDITIONS <br />1. All calls for inspeclion shall bf: made 24 hrs. in advance - phone 259•8810. <br />2. All work shall ba peAormed in accordance with this permit and wrrenl Gity ol [verett Design and Constmclion <br />StandarAs and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �'''-�' %°���.-�� � �:��• ���,�r� s- Z- Pif� <br />��' � � C� <br />Appfove � ansty ion � � Date <br />� � C <br />�1�� � � <br />FINAL INSPECTION li Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPAPTMEN7 <br />� 3200 Cedar Slreet <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOVJLEOGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />1� <br />• <br />� <br />� <br />� <br />a <br />The undcrsigned owner/applicanl hereUy ac�rees to hold and save harnr <br />less the Cdy ot [verett Irom any and all claims lor damapes, costs. <br />expenses, or causes ol action thal may arise because ol inslallalion <br />and maintenance ol Ihe improvement or other righbol�way use hereto <br />applied for and lurther ac�rees to remove same upon notice irom the <br />Ci�y and to replace pubhc property damaged thereby. <br />� f <br />�...��/ � � /' �' . � <br />� „ � ' <br />Signature cl Applicant Dale <br />WORK �UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF OATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPL[TION. THIS PEFihilT MAV BE <br />CANCEILED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />